MEDICARE: CRUZ BEHAVIORAL GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1992669063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRUZ BEHAVIORAL GROUP LLC

Provider Business Mailing Address
First Line	:	1687 BUCKEYE FALLS WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-4347
Country	:	US
Telephone Number	:	407-837-3039
Fax Number	:	689-223-7310

Provider Business Practice Location Address
First Line	:	1687 BUCKEYE FALLS WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-4347
Country	:	US
Telephone Number	:	407-837-3039
Fax Number	:	689-223-7310

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOSE M. CRUZ CARLO
Credential	:
Telephone Number	:	407-445-8915

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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